American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary treatment option for out-patient management of status migrainosus?

1. A single dose of aspirin

2. A several-day course of oral glucocorticoids

3. Oral sumatriptan

4. Chronic opioid therapy

The correct answer is: A several-day course of oral glucocorticoids

The primary treatment option for outpatient management of status migrainosus is a several-day course of oral glucocorticoids. This approach is particularly effective in managing acute migraine attacks that are prolonged and refractory to typical abortive therapies. Glucocorticoids like dexamethasone may help reduce inflammation and break the cycle of migraines, especially when patients have not responded to standard treatments. In the context of treating status migrainosus, glucocorticoids address both symptomatic relief and potential underlying inflammatory processes contributing to the prolonged status. This treatment can provide a rapid improvement in symptoms and help prevent the recurrence of migraines in patients who have experienced extended episodes. Other treatments such as oral sumatriptan may be effective for typical migraine attacks, but in the case of status migrainosus, the attacks are typically more severe, lasting longer than 72 hours, and may not respond as well to triptans alone. While a single dose of aspirin can provide relief for many migraine patients, it is unlikely to be sufficient for managing a prolonged episode like status migrainosus. Chronic opioid therapy is generally not recommended due to the risk of dependence and potential for rebound headaches, which can complicate the treatment of migraine disorders.